org at Baylor Health Sciences Library on For personal use only

Org at baylor health sciences library on for personal

This preview shows page 2 - 4 out of 8 pages.

Downloaded from nejm.org at Baylor Health Sciences Library on February 23, 2017. For personal use only. No other uses without permission. Copyright © 2015 Massachusetts Medical Society. All rights reserved.
Image of page 2
T h e ne w engl a nd jour na l o f medicine n engl j med 372;22 nejm.org May 28, 2015 2154 long-term institutional care making up the three largest sources of costs in Medicaid. One of Medicaid’s most widely embraced roles has been its ambitious expansion of coverage for children, a priority established by Congress that took effect in two waves — 1984–1990 and again in 1997–2009. 4 In 1967, Congress also established the Early and Periodic Screening, Diagnostic, and Treatment Program, which initiated Medicaid’s dual role as a financier of medical services and source of comprehensive care and prevention for America’s poorest children. In the Balanced Bud- get Act of 1997, Congress created CHIP, which provides coverage for children in families with in- comes that exceed the Medicaid eligibility thresh- old, with some states now covering children with family incomes as high as 300% of the federal poverty level. 14 For several decades, states have been moving away from fee-for-service payment and encour- aging or requiring Medicaid recipients to enroll in managed-care plans in hopes of decreasing or at least stabilizing their program costs. Under this model, states contract with managed-care plans that agree to provide all covered health care ser- vices in return for fixed (usually monthly) pay- ments, thus making state outlays more predictable. Although about two thirds of Medicaid benefi- ciaries were receiving services through managed- care plans by 2010, less than 30% of Medicaid dollars flowed to such plans because their en- rollees were typically parents and children, who are less expensive to cover than other Medicaid beneficiaries. Increasingly, states are requiring disabled and elderly beneficiaries with more ex- pensive conditions to enroll in managed-care plans, despite the lack of experience of such plans in serving these high-risk populations. In a related development, the nation’s largest private insurers are moving aggressively into the Medic- aid marketplace. 15 Despite the growing enthusi- asm for managed care in Medicaid, evidence is mixed on whether such programs actually save money or improve the quality of care. 16 Medicaid’s Effectiveness Following on the heels of Medicaid’s rapid expan- sion from 1980 into the 2000s, the ACA placed the program squarely in the national spotlight as one of the law’s two main approaches (along with subsidies for coverage through federal and state exchanges) to expanding health insurance cover- age to millions of previously uninsured Americans. In addition to expanding eligibility dramatically, the ACA also aimed to streamline the Medicaid application process and eliminate financial asset tests for many applicants in order to improve the participation rate among eligible adults — which was roughly 60% before passage of the ACA, owing to cumbersome enrollment and renewal procedures, variable program quality, stigma, and lack of awareness. 17-19
Image of page 3
Image of page 4

You've reached the end of your free preview.

Want to read all 8 pages?

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture